Approaching “Elective” Surgery in the Era of COVID-19

Abstract

The COVID-19 pandemic created unprecedented challenges for the healthcare system. In order to meet capacity demands, hospitals around the world suspended surgeries deemed to be “elective.” In hand surgery, there are numerous pathologies treated on an elective basis, but a delay or absence of care may result in poorer outcomes. We present here an ethical framework for prioritizing elective surgery during a period of resource scarcity. Instead of using the term elective, we define procedures that can be safely delayed based on three considerations. First, a safe delay is only possible if deferral will not result in permanent injury. Second, a delay in care will come with tolerable costs and impositions that can be appropriately managed in the future. Third, a safe delay will preserve the bioethical principle of patient autonomy. In considering these criteria, three case examples are discussed taking into account individual patient characteristics and the pathophysiology of the condition. This framework design is applicable to ambulatory surgery in any period of crises that may strain resources, but further considerations may be important if an operation requires hospital admission.

Epidemiology of distal radius fractures in children and adults during the COVID-19 pandemic – a two-center study

“…The COVID-19 pandemic altered the healthcare in the whole world in the year 2020 [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Although the causative coronavirus (SARS-CoV-2) can infect both adults and children, the majority of children have mild or asymptomatic course of the disease [13].…”

“…The COVID-19 pandemic has impeded general access to specialist care and altered the daily clinical practice and admission routines (in both emergency and primary-care settings) [14-17, 19, 21, 22]. Large group of Hospitals changed its working routines to specialcrisis mode, cancelling or limitting planned admissions [16,17,22,26]. Some physicians switched to contracted COVID-19, some shortened their office hours to limit the risk of infection.…”

“…Despite having suffered an injury, some patients, particularly the elderly and those with comorbidities, have avoided seeking medical help at emergency or trauma and orthopedic wards due to the fear of contracting COVID-19 [13,22]. In order to increase the safety of the medical personnel and reduce the number of admitted and operated patients, some hospitals increased the number of indications for conservative treatment of injuries and postponing surgery [25,26].…”

“…The reduction of the number of patients treated surgically with DRF during the COVID-19 pandemic may have consequences in the form of more complications in the future [25,26]. Surgical treatment of DRF is indicated especially in young patients with dislocated, multi-fragmented and intra-articular fractures.…”

“…Surgical treatment of DRF is indicated especially in young patients with dislocated, multi-fragmented and intra-articular fractures. In addition to the above factors, the epidemiology of DRF during the COVID-19 pandemic may be influenced by other factors, such as the medical and bioethical framework, the surgeon, and hospital policy (confounding factors) [25,26].…”